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11/26. Gliomatosis of the brain and spinal cord masquerading as infective lesions.

    BACKGROUND: Gliomatosis of the brain or spinal cord is an infiltrating glial neoplasm that shows widespread invasion of the central nervous system with relative sparing of the underlying cytoarchitecture. Acceptance of the idea that the condition represents a distinct entity remains controversial in the absence of conclusive pathogenetic data. The clinico-pathological problems and difficulties in the ante-mortem diagnosis as well as the clinical and pathological similarities to infective lesions are evaluated. methods AND RESULTS: Three cases of cerebral and spinal gliomatosis are presented that clinically mimicked infective lesions and were diagnosed and treated as such. The correct diagnosis in each case was only made at post-mortem examination. The ante-mortem diagnosis of this rare tumor remains difficult owing to poor correlation of clinical, neuroradiological, and neuropathological findings. CONCLUSION: Gliomatosis of the brain and spinal cord may simulate infective lesions owing to difficulty in ante-mortem diagnosis because of vagueness of physical, radiological, and pathological findings. It is a diagnostic pitfall particularly in our setting where there is a high incidence of hiv/AIDS and patients often present with opportunistic infections such as mycobacterial, fungal, and/or viral infections, which show an atypical clinical picture and radiological findings. Multifocal neurologic deficit with noncontrast enhancing lesions that show diffuse contiguous involvement with overall preservation of the spinal or cerebral architecture and do not respond to infective treatment could suggest a diagnosis of gliomatosis cerebri.
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keywords = nervous system
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12/26. Infectious CNS disease as a differential diagnosis in systemic rheumatic diseases: three case reports and a review of the literature.

    BACKGROUND: Immunosuppressive treatment of rheumatic diseases may be associated with several opportunistic infections of the brain. The differentiation between primary central nervous system (CNS) involvement and CNS infection may be difficult, leading to delayed diagnosis. OBJECTIVE: To differentiate between CNS involvement and CNS infection in systemic rheumatic diseases. methods and results: Three patients with either longstanding or suspected systemic rheumatic diseases (systemic lupus erythematodes, Wegener's granulomatosis, and cerebral vasculitis) who presented with various neuropsychiatric symptoms are described. All three patients were pretreated with different immunosuppressive drugs (leflunomide, methotrexate, cyclophosphamide) in combination with corticosteroids. magnetic resonance imaging of the brain was suggestive of infectious disease, which was confirmed by cerebrospinal fluid analysis or stereotactic brain biopsy (progressive multifocal leucoencephalopathy (PML) in two and nocardiosis in one patient). DISCUSSION: More than 20 cases of PML or cerebral nocardiosis in patients receiving corticosteroids and cytotoxic drugs for rheumatic disease have been reported. The clinical aspects of opportunistic CNS infections and the role of brain imaging, cerebrospinal fluid analysis and stereotactic brain biopsy in the differential diagnosis are reviewed.
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keywords = nervous system
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13/26. paecilomyces variotii central nervous system infection in a patient with cancer.

    paecilomyces variotii was isolated from two subsequent cerebrospinal fluid (CSF) specimens of a cancer patient. Identification was confirmed through beta-tubulin and rDNA ITS sequencing. MICs were determined for seven antifungal agents; the isolate was found to be susceptible to amphotericin b (AMB), itraconazole (ITZ), ketaconazole (KTZ) and 5-fluorocytosine (5FC) but resistant to fluconazole (FLZ) and miconazole (MCZ). Despite antimycotic therapy, the infection proved to be fatal.
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keywords = nervous system
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14/26. Treatment of central nervous system infection by vancomycin-resistant enterococcus faecium.

    Enterococci are uncommon causes of CNS infection. We describe a case of ventriculitis and Ommaya reservoir infection due to vancomycin-resistant enterococcus faecium successfully treated with the combination of i.v. quinupristin/dalfopristin and i.v. linezolid. The patient deteriorated after receiving three dosages of intraventricular quinupristin/dalfopristin. He recovered after discontinuation of intraventricular quinupristin/dalfopristin.
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keywords = nervous system
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15/26. central nervous system infections due to abiotrophia and Granulicatella species: an emerging challenge?

    Although abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci, were initially identified over 40 years ago, isolation of these pathogens from the central nervous system (CNS) was first noted only recently. Recognition of CNS involvement with these organisms is of great concern given the association of abiotrophia/Granulicatella infections with increased morbidity and mortality as well as greater bacteriologic failure and relapse rates. We describe A. defectiva and G. adiacens CNS infections in two patients and review the existing literature of CNS involvement with these bacteria. The clinical presentation and initial cerebrospinal fluid analysis has varied substantially across reported patients. While most infections have been characterized primarily by a localized infection (e.g., abscess), evidence of meningitis has usually also been present. Furthermore, nearly all cases have followed neurosurgical procedures suggesting possible introduction of the organism into the CNS at the time of surgery. Given the significant negative clinical impact of abiotrophia/Granulicatella infections, elucidation of the emerging epidemiology of CNS infections with these bacteria is warranted.
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keywords = nervous system
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16/26. Possible central nervous system infection by SARS coronavirus.

    On day 22 of illness, generalized tonic-clonic convulsion developed in a 32-year-old woman with severe acute respiratory syndrome (SARS). cerebrospinal fluid tested positive for SARS coronavirus (SARS-CoV) by reverse transcriptase-polymerase chain reaction. SARS-CoV may have caused an infection in the central nervous system in this patient.
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keywords = nervous system
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17/26. Central nervous system infection due to penicillium chrysogenum.

    penicillium chrysogenum was isolated from three subsequent cerebrospinal fluid (CSF) specimens of a 73-year-old male patient without immunological compromise. The isolated was tested against five antifungal agents according to the NCCLS M38-P macrodilution method. MICs were determined as follows: amphotericin b (AMB), 2 microg ml(-1); fluconazole (FLZ), 8 microg ml(-1); itraconazole (ITZ), 1 microg ml(-1); flucytosine (5FC), 0.125 microg ml(-1); and terbinafine (TRB), 0.06 microg ml(-1). The patient has been cured with FLZ.
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keywords = nervous system
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18/26. ventriculoperitoneal shunt infection due to serratia marcescens.

    serratia marcescens is an opportunistic Gram-negative bacillus that is most often associated with infections of the respiratory tract, urinary tract, wounds, and bloodstream. Infections of the central nervous system (CNS) with this pathogen are exceedingly infrequent. Even more rare is the association of S. marcescens with infections of ventriculoperitoneal (VP) shunts. To the best of our knowledge, we describe in this report not only the first case of a VP shunt infection by S. marcescens in an adult, but also the first case of a VP shunt infection by this organism in the absence of bowel perforation.
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keywords = nervous system
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19/26. Drug-induced aseptic meningitis in suspected central nervous system infections.

    This study presents eight patients with drug-induced aseptic meningitis (DIAM) admitted to our centre with an initial suspicion of central nervous system (CNS) infection. In all patients clinical findings, cerebrospinal fluid (CSF) examination, a cause-effect relationship according to the Naranjo adverse drug reactions probability scale and other diagnostic criteria required for DIAM recognition, were fulfilled. Nonsteroidal anti-inflammatory drugs were the most frequent cause of DIAM. In two cases, there was previous antimicrobial use. The time between use of the causative drug and onset of the symptoms ranged from 2 to 7 days. Clinical symptoms and CSF findings in patients with DIAM are indistinguishable from the early stage of infections of the CNS. Detailed anamnesis is essential, particularly related to medication use immediately prior to the appearance of symptoms of CNS impairment. In conclusion, the differential diagnosis of CNS infections should include DIAM.
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ranking = 5
keywords = nervous system
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20/26. Unusual presentation of central nervous system cryptococcal infection in an immunocompetent patient.

    The imaging findings of cryptococcosis affecting the brain in immunocompetent patients can be different from the more commonly described findings in immunocompromised patients. We report a case of an extremely unusual MR appearance of central nervous system cryptococcosis in a 49-year-old immunocompetent man.
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ranking = 5
keywords = nervous system
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